Advanced Medical-Surgical Nursing: NURS 47C Exam
III Comprehensive Study Guide with Practice Ǫuestions
& Expert-Tested Answers
1.A caregiver just received a patient presenting to the ED who is exhibiting signs of a
stroke. The patient is an 81 old female who weight 64 kgs. The husbands states she
started slurring her words and had left sided weakness about 30 minutes ago. The patient
CT scan comes back and the report reads "There is 2/3rds of brain tissue that is affected by
the ischemia". The provider writes a prescription to start alteplase. Select the next correct
nursing option.
A. Administer the 57.6 mg over 1 hour
B. Have another caregiver check your dosage calculation
C. Call the provider to question the prescription
D. Educate the patient about adverse effects of the medication - - correct ans- -Answer: C
Rational: The caregiver should identify that alteplase is contraindicated in this patient due
to the age and imaging report. The other answers would be correct if the medication was
indicated. Contraindications to alteplase: Age > 80, anticoagulation regardless of INR,
ischemic injury involving more than 1/3 of the brain tissue, NIHSS score >25, and evidence
of active blleding
2.A caregiver is preparing to administer alteplase to Becky, a 65 yo female who weights
61 kg. Select the correct options regarding correct alteplase administration. For
dosage calc, round to the nearest tenth. (sata)
A. The caregiver draws up 54.9 mg of the alteplase
B. The caregiver administers 5.5 mg as a bolus over the first minute via IVP
C. The caregiver sets the infusion to run over 60 minutes
D. The caregiver alternates taking the BP on the patients upper arm and forearm
E. The caregiver calls the doctor to obtain a CT scan after initiating the alteplase - - correct ans-
-Answers: A, C, C E
1
,Rational: The dose of alteplase is based off the patients weight, 0.9 mg/kg and is
administered over 60 minutes with the first 10% given as a bolus. There is a maximum dose
of 90 mg. B would be correct if the caregiver were to use an infusion pump for the bolus,
you never can manually push alteplase. 0.9 mg x 61 = 54.9, 10% of that is 5.49 (or rounded
to 5.5 in this case). A caregiver must be consistent with the BP device used. It must be used
in the same location as not to cause alterations in readings.
3.The caregiver is administering alteplase and at the 30 minute mark the patients blood
pressure spikes to 201/108 and complains of a severe HA and nausea. What is the
caregivers priority
action?
A. Notify the healthcare provider
B. Administer vitamin K
C. Administer FFP
D. Discontinue the infusion - - correct ans- -Answer: A
Rational: Discontinuing the infusion is the priority, then the caregiver would notify the HCP
and anticipate a likely prescription for FFP. Vitamin K is the reversal for warfarin not
alteplase
4.The caregiver is caring for a patient treated with alteplase following a stroke. Which
assessment finding is the highest priority for the caregiver to report to the primary health
care provider?
A. Patient has a new-onset mild headache.
B. Patient's blood pressure is 194/120 mm Hg.
C. Patient has left hemiparesis.
D. Patient continues to be drowsy. - - correct ans- -Answer: B
Rational: Elevation in BP is the priority finding when administering alteplase because of the
risk for hemorrhagic stroke
5.A caregiver has just discontinued alteplase secondary to blood pressure elevation of
201/108. The caregiver promptly notifies the provider and should anticipate what
medication to treat the severe HTN?
2
,A. Labetalol
3
, B. Dopamine
C. Dobutamine
D. Norepinephrine - - correct ans- -Answer: A
Rational: Labetalol is a beta blocker and works by relaxing blood vessels and slowing the
HR which decreases blood pressure. B, C, and D will have an inotropic effect on the heart
which will increase BP
6.During alteplase administration the caregiver should monitor the BP every mins
during the infusion followed by every mins for hours? (open
response) - - correct ans- -Answer: The caregiver should monitor the BP q 10-15
minutes during the infusion followed by q 30 minutes for 6 hours after the infusion
7.A caregiver is assessing a patient 48 hours post stroke. The caregiver is monitoring for an
increase in ICP during this time. What clinical manifestation would the caregiver suspect
to appear
FIRST if the patient were to have an increase in ICP?
A. Severe HA
B. Constricted, non reactive pupils
C. Severe HTN
D. Decrease in LOC - - correct ans- -Answer: D
Rational: A decrease in LOC is the first sign of increased ICP. This should promptly be
reported to the HCP. B, C, D are late clinical manifestations of increase in ICP.
8.A caregiver is taking care of a patient named Tim. He is post 48 hours following a stroke.
The caregiver goes into the room and he is restless and irritable. He is confused and is
exhibiting signs of aphasia and dysarthria. The caregiver takes Tim's BP and it is 210/84
and his HR is 44. The caregiver should suspect what is happening? What specific clinical
manifestation is presenting with Tim? (open response) - - correct ans- -Answer: Tim is
experiencing an
increase in ICP based on this confusion, decrease in LOC, and signs of aphasia and
dysarthria. In addition to this Tim's severe HTN, widened pulse pressure, and bradycardia is
the clinical manifestation of Cushings triad, a late sign of increased ICP.
4
III Comprehensive Study Guide with Practice Ǫuestions
& Expert-Tested Answers
1.A caregiver just received a patient presenting to the ED who is exhibiting signs of a
stroke. The patient is an 81 old female who weight 64 kgs. The husbands states she
started slurring her words and had left sided weakness about 30 minutes ago. The patient
CT scan comes back and the report reads "There is 2/3rds of brain tissue that is affected by
the ischemia". The provider writes a prescription to start alteplase. Select the next correct
nursing option.
A. Administer the 57.6 mg over 1 hour
B. Have another caregiver check your dosage calculation
C. Call the provider to question the prescription
D. Educate the patient about adverse effects of the medication - - correct ans- -Answer: C
Rational: The caregiver should identify that alteplase is contraindicated in this patient due
to the age and imaging report. The other answers would be correct if the medication was
indicated. Contraindications to alteplase: Age > 80, anticoagulation regardless of INR,
ischemic injury involving more than 1/3 of the brain tissue, NIHSS score >25, and evidence
of active blleding
2.A caregiver is preparing to administer alteplase to Becky, a 65 yo female who weights
61 kg. Select the correct options regarding correct alteplase administration. For
dosage calc, round to the nearest tenth. (sata)
A. The caregiver draws up 54.9 mg of the alteplase
B. The caregiver administers 5.5 mg as a bolus over the first minute via IVP
C. The caregiver sets the infusion to run over 60 minutes
D. The caregiver alternates taking the BP on the patients upper arm and forearm
E. The caregiver calls the doctor to obtain a CT scan after initiating the alteplase - - correct ans-
-Answers: A, C, C E
1
,Rational: The dose of alteplase is based off the patients weight, 0.9 mg/kg and is
administered over 60 minutes with the first 10% given as a bolus. There is a maximum dose
of 90 mg. B would be correct if the caregiver were to use an infusion pump for the bolus,
you never can manually push alteplase. 0.9 mg x 61 = 54.9, 10% of that is 5.49 (or rounded
to 5.5 in this case). A caregiver must be consistent with the BP device used. It must be used
in the same location as not to cause alterations in readings.
3.The caregiver is administering alteplase and at the 30 minute mark the patients blood
pressure spikes to 201/108 and complains of a severe HA and nausea. What is the
caregivers priority
action?
A. Notify the healthcare provider
B. Administer vitamin K
C. Administer FFP
D. Discontinue the infusion - - correct ans- -Answer: A
Rational: Discontinuing the infusion is the priority, then the caregiver would notify the HCP
and anticipate a likely prescription for FFP. Vitamin K is the reversal for warfarin not
alteplase
4.The caregiver is caring for a patient treated with alteplase following a stroke. Which
assessment finding is the highest priority for the caregiver to report to the primary health
care provider?
A. Patient has a new-onset mild headache.
B. Patient's blood pressure is 194/120 mm Hg.
C. Patient has left hemiparesis.
D. Patient continues to be drowsy. - - correct ans- -Answer: B
Rational: Elevation in BP is the priority finding when administering alteplase because of the
risk for hemorrhagic stroke
5.A caregiver has just discontinued alteplase secondary to blood pressure elevation of
201/108. The caregiver promptly notifies the provider and should anticipate what
medication to treat the severe HTN?
2
,A. Labetalol
3
, B. Dopamine
C. Dobutamine
D. Norepinephrine - - correct ans- -Answer: A
Rational: Labetalol is a beta blocker and works by relaxing blood vessels and slowing the
HR which decreases blood pressure. B, C, and D will have an inotropic effect on the heart
which will increase BP
6.During alteplase administration the caregiver should monitor the BP every mins
during the infusion followed by every mins for hours? (open
response) - - correct ans- -Answer: The caregiver should monitor the BP q 10-15
minutes during the infusion followed by q 30 minutes for 6 hours after the infusion
7.A caregiver is assessing a patient 48 hours post stroke. The caregiver is monitoring for an
increase in ICP during this time. What clinical manifestation would the caregiver suspect
to appear
FIRST if the patient were to have an increase in ICP?
A. Severe HA
B. Constricted, non reactive pupils
C. Severe HTN
D. Decrease in LOC - - correct ans- -Answer: D
Rational: A decrease in LOC is the first sign of increased ICP. This should promptly be
reported to the HCP. B, C, D are late clinical manifestations of increase in ICP.
8.A caregiver is taking care of a patient named Tim. He is post 48 hours following a stroke.
The caregiver goes into the room and he is restless and irritable. He is confused and is
exhibiting signs of aphasia and dysarthria. The caregiver takes Tim's BP and it is 210/84
and his HR is 44. The caregiver should suspect what is happening? What specific clinical
manifestation is presenting with Tim? (open response) - - correct ans- -Answer: Tim is
experiencing an
increase in ICP based on this confusion, decrease in LOC, and signs of aphasia and
dysarthria. In addition to this Tim's severe HTN, widened pulse pressure, and bradycardia is
the clinical manifestation of Cushings triad, a late sign of increased ICP.
4
